Objectives The primary aim of this study was to identify the ease and safety of office‐based lower airway endoscopy (OLAE) in patients with and without comorbidities. In addition, we identified the most common indications for OLAE and the associated diagnosis. Methods A retrospective review on 567 patients and 706 in‐office flexible fiberoptic procedures was performed. Using a previously established grading system, the ease of visualization of the subglottis, trachea, and carina was assessed, in addition to the overall ease of the exam. Results Four hundred and eighty‐eight videos were available for review. Of those, 105 videos included an OLAE, accounting for 21.5% of all procedures. Laryngomalacia was the most common diagnosis in 35 of 105 (36%) OLAE. For all laryngomalacia cases, the overall ease was found to be on average 2.15 (standard error 0.12). Fisher exact testing showed a statistical significance in the ability to visualize the trachea between the types of Laryngomalacia (LM) (P = .035). Fisher exact testing was performed comparing LM types I, II, or III, and combined types of LM; no statistical difference was found between groups. In 4.76% of OLAE procedures, a subglottic pathology was diagnosed. Comorbidities were found in OLAE 26 of 105 patients. There were no complications identified. Conclusion We found OLAE more challenging than previously reported. OLAE of combined types of laryngomalacia was subjectively more difficult, but this difference did not reach statistical significance. OLAE continues to be a safe alternative to operative laryngoscopy in pediatric patients and appears safe in those with comorbidities when precautions are taken. Level of Evidence 4. Laryngoscope, 131:E649–E652, 2021

Background Allergy and asthma are often diagnosed concomitantly. Patients with both diagnoses might need to have a more targeted approach to reduce the symptomatic burden and severity of disease. Objective This study was designed to explore the relationship between specific allergen sensitization, and asthma diagnosis and severity with the hypothesis that patients who tested positive to a higher allergy class of response and to more allergens would be more likely to have severe asthma. Methods A retrospective review was performed on 1419 charts that had a positive IgE allergy class blood test between 2014 and 2018. A total of 701 patients had one or more positive tests and a diagnosis of asthma. Patient demographics and pertinent variables including all clinic and ED visits, specific allergy and class of response, and information related to their asthma treatment and severity were recorded. Logistic regression was used to analyze the likelihood of asthma diagnosis, concomitant diagnosis of asthma and allergic rhinitis, and measures of asthma severity. Results Higher class of response to cat dander 1.24 (1.09, 1.41), dog dander 1.29 (1.13, 1.47), lamb's quarter 1.35 (1.06, 1.70), house dust 1.41 (1.11, 1.82), Cladosporium herbarum 1.35 (1.07, 1.67) or cockroach 1.56 (1.00, 2.44) showed increased odds of hospitalizations. There was a statistically significant difference between the average number of classes for patients with and without asthma ( P < .001), and those with and without steroids ( P < .001). Conclusions This study found that positivity to cat dander, dog dander, some fungus, and house dust was associated with more severe asthma.

RATIONALE: AERD presents as adult-onset asthma associated with nasal polyposis and hypersensitivity reactions to cyclooxygenase-1 inhibitors. It is associated with persistent blood eosinophilia that decreases during aspirin challenges. Allergic asthma is another asthma phenotype associated with environmental allergies and eosinophilia. We aimed at detecting transcriptomic signatures in eosinophils associated with AERD phenotypes. METHODS: We isolated blood eosinophils from fourteen AERD and six allergic asthma patients (ATA) patients. We extracted RNA from these eosinophils at baseline and 120 minute timepoints before/after the onset of the hypersensitivity reaction to aspirin challenge (AERD) or before/after non-reaction to aspirin administration (ATA). We performed whole transcriptome profiling using Smartseq2 protocol with indexed PE sequencing run on samples using Illumina HiSeq 4000. RESULTS: Principal component (PC) informed analysis revealed a strong enrichment of genes associated with chemokine-mediated pathway, positive regulation of angiogenesis, and cellular response to tumor necrosis factor pathways using gene ontology.A comparison of the baseline to 120 minutes after aspirin challenge revealed a total of 1458 differentially expressed genes (DEGs) for AERD phenotype and 1088 for the ATA phenotype. Only 173 DEGs (7%) were shared among these 2 phenotypes with the rest of DEGs being unique to each phenotype. Gene candidates unique to AERD included CCR3 (eosinophil activation), MMP9 (cell migration), DYRK1A(cell cycle regulation), and ADSS (cell proliferation), while RSAD2(gamma-interferon inducer) and OXER1(oxoieicosanoid receptor-1) were shared by both phenotypes. CONCLUSIONS: Transcriptome consistent with cell activation in response to aspirin challenges indicates a unique response of blood eosinophils to cyclooxygenase-1 inhibition in AERD patients.

Objectives/Hypothesis: The aim of this study is to establish a correlation between persistent cough (PC) and asthma diagnosis and its severity. We hypothesize that patients with past or current diagnosis of PC may have more severe asthma diagnosis and thus poor responsiveness to treatment.Study Design: Retrospective chart review. Methods: A retrospective review was performed on 699 charts that had a positive immunoglobulin E (IgE) allergy blood test between 2014 and 2018, and a positive asthma diagnosis. Patient demographics and asthma severity parameters such as number of clinic and emergency department (ED) visits, asthma treatment, and number of medications were recorded, as well as PC diagnosis. Logistic regressions were used to analyze the likelihood of severe asthma diagnosis in patients with PC.Results: A total of 55% of patients were treated with oral corticosteroids in the PC group, compared to 41% in those without (P < .001). The mean number of hospitalizations from the ED was higher for patients with PC 0.65 (2.47) versus 0.38 (1.18) P < .05. Patients with asthma and PC, positive to lamb's quarter 2.92 (95% confidence interval [CI] 1.63, 5.22; P < .001), showed a higher likelihood of ED visits. Positivity to cat dander 2.09 (95% CI 1.03, 4.59; P < .05), lamb's quarter 2.96 (95% CI 1.50, 5.79; P < .002), dog dander 3.37 (95% CI 1.54, 8.45; P < .004) showed a higher likelihood of hospitalizations due to asthma.Conclusion: Patients with PC, especially those with a positive IgE allergy class test to cat dander, dog dander, house dust, Alternaria tenuis, or lamb's quarter can have a more severe asthmatic presentation.